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Endocrinology and Metabolism Pregnancy and Diabetes Screening Screen select women with risk factors for diabetes at the beginning of gestation. Screen all women for gestational diabetes at 24 to 28 weeks of gestation (eOR) or after 28 weeks (USpSTF) with the 75 gram 2 hour OGTT. DON'T BE TRICKED r Women with a history of gestational diabetes are at very high risk for developing type 2 diabetes and require annual screening following delivery. Treatment Glycemic targets in pregnancy include premeal plasma glucose <95 mg/dl, l-hour postprandial values <140 mg/dl, and 2_hour postprandial values <120 mg/dL. Try lifestyle interventions as initial treatment, with the addition of insulin if glycemic targets are not met. Management strategies in pregnant women with diabetes are different from those in other patients with diabetes: o Insulin should replace oral hypoglycemic agents. . ACE inhibitors, ARBs, and cholesterol-lowering drugs should be stopped before pregnancy. . A comprehensive eye examination should be completed once per trimester. Employ aggressive BP control to avoid worsening ofdiabetic nephropathy and retinopathy. Antihypertensive agents that can be safely used during pregnancy include methyldopa, p-blockers (except atenolol), calcium channel blockers, and hydralazine. Hypoglycemia in Patients Without Diabetes Diagnosis Evaluate for hypoglycemia if the criteria for Whipple triad are met: neuroglycopenic symptoms, hypoglycemia <55 mg/dt., and resolution of symptoms with glucose ingestion. Hypoglycemic disorders are classified as postprandial or fasting. Postprandial hypoglycemia lzpically occurs within 5 hours of the last meal and is commonly caused by previous gastrectomy or gastric bypass surgery.

Hypoglycemia in Patients Without Diabetes Diagnosis Evaluate for hypoglycemia if the criteria for Whipple triad are met: neuroglycopenic symptoms, hypoglycemia <55 mg/dt., and resolution of symptoms with glucose ingestion. Hypoglycemic disorders are classified as postprandial or fasting. Postprandial hypoglycemia lzpically occurs within 5 hours of the last meal and is commonly caused by previous gastrectomy or gastric bypass surgery. STUDY TABLE: Diagnosis of Nondiabetic Fasting Hypoglycemia Condition Diagnosis Surreptitious use of oral hypoglycemic Patient has access to hypoglycemic agents. Serum C-peptide levels are inappropriately agents elevated at time of hypoglycemia. Perform urine screen for sulfonylurea and meglitinide metabolites. Surreptitious use of insulin Patient has access to insulin. Serum C-peptide levels are low at time of hypoglycemia. lnsulinoma Perform 72-hour fast and document fasting plasma glucose level <45 mg/dL, serum insulin >5-6 mU/L, and elevated C-peptide levels. lf positive, schedule abdominal CT. Substrate deficiency Starvation, liverfailure, or sepsis; suppressed hepatic glucose production (alcoholism; cortisol or GH deficiencies) 53